Welcome to The Body PRO Newsletter, a bi-weekly review of the latest breaking news and research in HIV medicine, aimed specifically at informing health care professionals.

June 29, 2009

In This Newsletter:

  HIV TREATMENT & PATHOGENESIS

Researchers Pinpoint How HIV Is Able to "Hijack" Immune Cells
A team of Canadian researchers says it has determined the mechanism by which HIV "hijacks" a cell's machinery. "HIV-1 commandeers the host cell's endosomal machinery to traffic its structural proteins and RNA genome," explains Andrew Mouland, Ph.D., one of the researchers. "This is how these key components of HIV-1 so efficiently get to the plasma membrane, where the virus can begin to assemble." Finding a way to block the trafficking of the RNA genome may provide a new avenue for HIV treatment, the researchers suggest. The study was published in the May issue of the Journal of Biological Chemistry. (Press release from McGill University)


New Approach Utilizing HDAC Inhibitors May Open Frontier in Antiretroviral Therapy
Researchers suggest that histone deacetylase (HDAC) inhibitors may have a role to play in the attempt to assault latent HIV reservoirs. HDAC is an enzyme that is believed to contribute to the maintenance of those HIV reservoirs. An Italian laboratory study suggests that, by adding buthionine sulfoxamine to an HDAC inhibitor, it may be possible to enhance the HDAC inhibitor's ability to reactivate pockets of HIV-infected cells that current antiretrovirals have been unable to reach. Many researchers believe that these latently infected cells are the reason that HIV eradication remains elusive with today's antiretrovirals. (Study summary from aidsmap.com)


Key to HIV Eradication May Lie in Memory T Cells, Researchers Say
HIV eradication has also been on the minds of researchers at Vaccine & Gene Therapy Institute (VGTI) Florida and the University of Montreal. They report in the June 21 issue of Nature Medicine that they have successfully pinpointed two subsets of memory T cells in which HIV is able to persist even when a patient's viral load is fully suppressed on antiretroviral therapy. They also report they have determined the mechanism by which these cells remain alive. Next, the researchers plan to use new forms of treatment to stop those memory T cells from replenishing themselves. (Article from The Body)

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Early HAART Initiation Can Dramatically Cut Death Rate of HIV-Infected Patients in Developing Countries, Study Says
In the U.S. and Europe, official antiretroviral therapy guidelines recommend initiating therapy before a patient's CD4+ cell count drops below 350. But in many resource-limited countries, it is still standard practice to wait until a patient's CD4+ cell count dips under the 200 mark. That practice may be responsible for quadrupling the number of HIV-infected patients who die in those countries, according to the results of a major new study. The study, which took place in Haiti, but was funded by the U.S. National Institute of Allergy and Infectious Diseases, also found that delayed HAART initiation doubled a patient's risk for developing tuberculosis. (Press release from the U.S. National Institute of Allergy and Infectious Diseases)


HIV entering a cellNew Video Captures Movement of HIV Between Immune Cells
HIV pathogenesis research has finally gone YouTube-friendly: Researchers from the University of California-Davis have utilized video microscopy (and green fluorescent protein tagging) to record HIV passing directly from an infected T cell into an uninfected T cell, effectively confirming a theory about how HIV manages to avoid immune detection. The findings may open new avenues of HIV prevention and treatment research, the scientists say. (Article from the Center for Biophotonics Science and Technology at the University of California-Davis)


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  HIV POLICY & TREATMENT ACCESS IN THE U.S.

Lost Funding Forces Arizona ADAP to Dramatically Cut Drug Formulary
When the month of June started, the formulary for Arizona's AIDS Drug Assistance Program (ADAP) took up seven printed pages. When it ends, only three pages will be left. A combination of funding cuts, higher costs and more individuals applying for aid has left the Arizona ADAP in an almost impossible position: either cut its number of clients or cut the amount of assistance it can give. It went with option No. 2. Arizona's ADAP says it will continue to cover all antiretrovirals and drugs to prevent or treat opportunistic infections, but many other drugs, including those used to manage anemia, anxiety, diabetes and pain, will be dropped from its formulary beginning July 1. (Article from the U.S. Centers for Disease Control and Prevention)


HIV Physicians' Organization Chimes in on U.S. Health Care Debate
As the health care reform debate heats up in the U.S. Congress, important HIV organizations from across the country are lining up to advocate for people with HIV. HIV Medicine Association (HIVMA), which represents many HIV physicians, recently joined the debate on the side of the Obama administration: It says that including a "public plan option" as an alternative to private insurance could go a long way toward providing affordable care to people with HIV who currently have no insurance at all. "A public plan option will better ensure all of our patients have the opportunity to benefit from HIV treatment and live healthy and productive lives," says HIVMA's chairperson, Arlene Bardeguez, M.D., M.P.H. (Press release from HIV Medicine Association)

HIVMA has also created a handy, nine-point list of key goals it feels the U.S. national health care reform plan must achieve.

The story of HIV and health care reform in the U.S. continues to unfold. Check back often to browse The Body PRO's growing collection of articles on the issue!


HIV Advocates Monitor U.S. Health Care Debate
As the Obama administration moves ahead with plans for historic U.S. health care reforms, HIV advocates are working to safeguard the interests of HIV-infected patients. Given the current economic climate, advocates are keen to ensure that upcoming reforms will guarantee at least the same level of access to HIV care, testing and prevention that is now available through Medicaid, Medicare and the Ryan White program. Along those lines, the HIV organization Project Inform and other advocates have developed a policy platform of HIV-related issues for the U.S. Congress to consider as it hashes out reforms. That platform includes calls for government-provided health insurance and expanded Medicaid eligibility. (Article from Project Inform)


2012 International AIDS Conference Will Be in Washington, D.C. -- If the U.S. Drops Its HIV Visitor Ban
Why has there been no International AIDS Conference in the U.S. for almost 20 years? Julio Montaner, M.D., president of the International AIDS Society (IAS), puts it bluntly: "A fundamental principle of the IAS is that people living with HIV should be able to participate ... without restrictions at HIV conferences." Hence, "The conference has not been held in the U.S. since 1990 because of the ban on entry of people living with HIV," he says. However, if the U.S. finally drops the last vestiges of its 22-year-old ban on the entry of HIV-infected foreigners, the IAS says it will hold its 2012 conference in Washington, D.C. (Press release from the International AIDS Society)


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  HIV TRANSMISSION & TESTING

New U.S. "HIV/AIDS Atlas" Shows Graphic Representation of HIV Rates by County
U.S. health care workers, officials and advocates now have a unique way to quickly pinpoint areas with high HIV/AIDS prevalence rates: an online "HIV/AIDS Atlas" created by the National Minority Quality Forum. The atlas shows a vivid, graphic representation of HIV rates by county in all 50 states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands. It promises to provide HIV advocates and policymakers with a powerful new tool in their efforts to fight HIV/AIDS in the areas of the U.S. that are most in need of services, such as urban areas and specific sections of Southern states. (Article from The Body)


Physicians Urged to Make HIV Testing Routine
There are more than 1 million people living with HIV in the U.S. -- and a quarter of them don't know they're infected. That's why major awareness events, such as U.S. National HIV Testing Day (which took place last Saturday, June 27), are so important. This year, the American Academy of HIV Medicine (AAHIVM), one of the largest HIV specialist organizations in the U.S., is joining the push for an expansion of routine HIV testing: It called on all medical providers to perform at least one HIV test during National HIV Testing Day, and is also working with the U.S. Centers for Disease Control and Prevention to develop programs to help health care providers implement routine testing year-round for everyone between the ages of 13 and 64. (Press release from AAHIVM)

On a related note, two of the United States' top HIV health officials -- Anthony Fauci, M.D., and Carl Dieffenbach, Ph.D. -- wrote a commentary discussing the idea of universal HIV testing and treatment as an HIV prevention strategy. Their article was published in the June 10 issue of the Journal of the American Medical Association.


Pre-Exposure HIV Prophylaxis: How Would It Be Implemented?
Ongoing studies continue to examine whether pre-exposure prophylaxis (PrEP) -- the practice of using antiretrovirals in at-risk patients before an HIV exposure has occurred -- is safe and effective. But it's not too early to start thinking about how PrEP would actually be utilized if it were to become widely available. Which HIV-uninfected patients would take it? Would they receive PrEP for the duration of their lives? Would patients even be receptive to the idea of taking antiretrovirals regularly? Who would cover the cost? In this insightful, patient-friendly overview, the HIV organization Project Inform looks into its crystal ball and offers its take on the answers to these and other PrEP-related questions. (Article from Project Inform)


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Medical Review

This e-mail newsletter was reviewed for clinical accuracy by Benjamin Young, M.D., Ph.D. (Read his bio.)

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Also Worth Noting

CME/CE Central: Get the Credit You Deserve

Getting your CME/CE certificates at The Body PRO's CME/CE Central is quick and easy. Earn credit for an array of outstanding activities, including:

•  An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation, by David Wohl, M.D.

•  Top 10 HIV Clinical Developments of 2008, by David Wohl, M.D.

•  New Developments in HIV/Hepatitis C Coinfection Management and Epidemiology: Highlights From ICAAC/IDSA 2008, by Daniel Fierer, M.D.

•  Evolving Options for First-Line Therapy: Highlights From ICAAC/IDSA 2008, by David Wohl, M.D.

•  Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008, by Benjamin Young, M.D., Ph.D.

•  CCR5 Antagonists and Tropism Testing in Clinical Practice, by David Hardy, M.D.

A wealth of additional activities awaits you at The Body PRO's CME/CE Central!

Activist Central

  Tell Congress to Make Health Care Reform Work for People With HIV/AIDS!

  Tell Abbott That We Will Not Accept a High Price for Its New Ritonavir!

  Tell CVS: Don't Restrict Access to Condoms!

  Write a Letter to President Obama to Support the Action Plan for Rapid Scale-Up of Routine, Voluntary Testing

  ART Initiation at <350 -- Call on WHO and UNAIDS to Save Lives! AIDS Healthcare Foundation is pushing for an update to official global treatment guidelines.